MEDICARE: NATHANIEL JOHN BRUTEJCEK LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3488	MN

General Provider Information

NPI Number	:	1538882964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL JOHN BRUTEJCEK LPCC

Provider Business Mailing Address
First Line	:	5353 WAYZATA BLVD STE 510
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1340
Country	:	US
Telephone Number	:	952-254-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	5353 WAYZATA BLVD STE 510
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1340
Country	:	US
Telephone Number	:	952-254-3557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	06/04/2026

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